Mixed messages about medical services

[Krapenhoeffer]

These were cadets without Basic First Aid. Acting as part of a "Emergency First Aid Response Team." Now, first CAP shouldn't even be there. They should have paid for off duty EMTs, as this was a totally planned event. Besides, an EMT is going to have a direct link to the rest of the EMS system, and doesn't have to work through the 911 dispatcher (love them, but I never like having to call them. Their lists are far to annoying. Rather use my radio).

Not to mention, I'd take the Boy Scout over a ARC certified first aid-type person any day. (Hint: The new ARC Wilderness First Aid was based off the Boy Scout curriculum). I mean, the latest first aid/CPR classes don't even teach patient assessment anymore.

Now, the Boy Scouts in my neck of the woods had to practice on Mr. Plastic Man, not just explain how they would do it.

If this was a CAP activity, I would be Mr. EMT man in my CAP uniform, because my wing's interpretation of 60-3 (and my insurance company) say I can. Since this is a BSA activity, I would be in my EMS uniform, as my wing's interpretation of 60-3 say I can't.

[Major Lord]

"If this was a CAP activity, I would be Mr. EMT man in my CAP uniform, because my wing's interpretation of 60-3 (and my insurance company) say I can. Since this is a BSA activity, I would be in my EMS uniform, as my wing's interpretation of 60-3 say I can't."

I am sorry, do you mean to say that your wing allows you to act as an EMT while on CAP activities?

Major Lord

[Krapenhoeffer]

Let me explain. 1st. I'm usually not just sitting around waiting for someone to get hurt. I'm usually busy doing something else CAP-related, until somebody gets injured. Then, thanks to the fact that I'm technically on duty 24/7 (and that comes with my insurance as well). I have the authorization of the State to act. The Wing's interpretation of 60-3 is more or less "You have insurance? Good. Go do stuff." And then I do stuff. Every case I've handled was resolved at the scene (that will likely change now that the bees are out, and the summer influx of new members...). If somebody needed transport to the hospital, my lovely radio has the dispatch frequencies (personally owned), and I call for the rig.

At a BSA activity, I would likely just be sitting around. Bored. Maybe working on a project or something. But I'd be in my cool white aviator shirt and BBDU trousers! And I would likely have the rig out with me.

[Eclipse]

Yes, of course you can go do "stuff", however the minute you start "stuff", and for the duration of "stuff" you are not acting as a CAP member, and if you implied you were, you'd be on thin ice at best.

CAP provides members liability protection and resources for activities and actions within its scope.  Advanced medical care is out of scope.
Its no different than if I decide to "help" the ARC during a mission setup their network infrastructure or troubleshoot a database.  If things start smoking or anyone gets hurt, CAP, Inc. will not cover the costs, regardless of which shirt I am wearing, because technology support
is not within CAP's scope.

[Ned]

Let me explain. 1st. I'm usually not just sitting around waiting for someone to get hurt. I'm usually busy doing something else CAP-related, until somebody gets injured. Then, thanks to the fact that I'm technically on duty 24/7 (and that comes with my insurance as well). I have the authorization of the State to act. The Wing's interpretation of 60-3 is more or less "You have insurance? Good. Go do stuff." And then I do stuff. Every case I've handled was resolved at the scene (that will likely change now that the bees are out, and the summer influx of new members...). If somebody needed transport to the hospital, my lovely radio has the dispatch frequencies (personally owned), and I call for the rig.

At a BSA activity, I would likely just be sitting around. Bored. Maybe working on a project or something. But I'd be in my cool white aviator shirt and BBDU trousers! And I would likely have the rig out with me.

As if I was not frightened enough for the future of CAP.

It bears repeating that you absolutely may not - under any circumstances - render medical care to members or non-members while you are at a CAP activity in anything but a genuine "life or limb" emergency.  (In an genuine emergency, you can and should do what needs to be done up to the level of your training.)

It simply doesn't matter if you have insurance or not.  It doesn't matter if the state thinks you are "on duty 24/7" or not.

You can't do it, period.  That's what the regulation says.  Honest, take a moment and read it.  You won't find any exceptions for members covered by their own insurance or if they happen to be on duty for another entity, or even if they have their own rig hidden under a bush.

Members who render non-emergency care to anyone risk the very existence of CAP, Inc.

So don't do it.


Ned Lee
Former CAP Legal Officer

[Flying Pig]

Contrary to what most people believe (even those in the profession) you are not required to be on duty 24/7.  Most of what that is, is people putting that requirement on themselves.  A lot of LE officers claim that as well, when in reality, when I am off, I am off and not required in any capacity to act.
Morally is a different story, legally is another thing.  I am an EMT.  Nobody can force me to render aid when I am on my personal time just because I happened to take an EMT course.  I dont owe my life or my personal time to the Counties EMS authority. 
As far as CAP, if something happens, act if you need to.  Otherwise, call an ambulance.  If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

[Ned]

If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

Robert,

No.  It is not fine for a CAP member at an activity to render non-emergency aid ever.  There is no provision in the regulation for "dual status" members who are wearing a CAP uniform but claim to be acting under the authority of their EMS employer/police agency employer/USAFR status or whatever.

As a practical matter, the victim is not going to care what sort of clothing the person saving their life is wearing.  The flip side of that is if something - God forbid - should go wrong and there is a non-optimal outcome, the court is not going to sort out any sort of dual-status and CAP, Inc is going to be on the hook for what the "state licensed EMT1 employed by the Barney Ambulance Company but who happened be be dressed as a CAP Capt at a CAP activity" did or didn't do that resulted in the non-optimal outcome.

(Sure, there could be litigation following the judgment where CAP and the Barney Ambulance Company fight it out, but it will still result in a judgment against CAP, Inc for which we have no insurance coverage.  It only takes a couple of million dollars in malpractice awards before we are simply out of business.)

So, the bottom line is that the regulation is unambiguous and binding:  CAP members at an activity may not under any circumstances render first aid in anything other than a genuine life or limb emergency. 

Things like self-insurance, "dual status", "on duty status" are simply irrelevant distracters to the discussion.

Ned Lee
Former CAP Legal Officer

EDIT- Added the word "first" before the word "aid" in the penultimate sentence.  My bad.

[Flying Pig]

If you are on duty at a CAP activity and happen to be a CAP member, then fine.  But its your EMS position you are acting under, not that you are a CAP member who is also an employed EMT in your day job.

Robert,

No.  It is not fine for a CAP member at an activity to render non-emergency aid ever.  There is no provision in the regulation for "dual status" members who are wearing a CAP uniform but claim to be acting under the authority of their EMS employer/police agency employer/USAFR status or whatever.

As a practical matter, the victim is not going to care what sort of clothing the person saving their life is wearing.  The flip side of that is if something - God forbid - should go wrong and there is a non-optimal outcome, the court is not going to sort out any sort of dual-status and CAP, Inc is going to be on the hook for what the "state licensed EMT1 employed by the Barney Ambulance Company but who happened be be dressed as a CAP Capt at a CAP activity" did or didn't do that resulted in the non-optimal outcome.

(Sure, there could be litigation following the judgment where CAP and the Barney Ambulance Company fight it out, but it will still result in a judgment against CAP, Inc for which we have no insurance coverage.  It only takes a couple of million dollars in malpractice awards before we are simply out of business.)

So, the bottom line is that the regulation is unambiguous and binding:  CAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency. 

Things like self-insurance, "dual status", "on duty status" are simply irrelevant distracters to the discussion.

Ned Lee
Former CAP Legal Officer

Right....Thats what I meant.  I meant on duty as an employed EMT at a CAP activity.  Meaning that for some reason, the CAP activity asked for the local Ambulance to stand by at an activity for whatever reason.  In that case, you are there as an EMT.  Your CAP membership status is of no consequence.  On the flip side of that, just because you happen to be an employed EMT in your day job does not give you authorization or coverage to act as a "CAP EMT" (If there were such an animal) as a CAP member.  Basically, the CAP EMT/MD or Nurse badge does nothing to protect you or CAP from liabilty nor give you the authority to provide medical care AS a CAP member.  Your screwed should something go wrong.     As  a CAP member, Nobody expects you to watch a cadet die while choking on a hot dog.  Call an ambulance, render the necessary aid, stabilize and then step back. Clear as mud?

Added Later  I think we should do away with the Medical badges totally.  All they are is ego boosters anyway.  Lets make a badge for members who are cops also while we are at it.   It just adds confusion.  If you recognize peoples skills, they expect you want them to use it.  We DO NOT have medical services, just like we don't have LE services.  Heck...at least we actually have a counter drug program and work with LE agencies.  We dont have medical services and we dont work with medical providers.
We have lawyers and Chaplain badges because we have lawyers and Chaplains.  Why do we have Medical Badges or give advanced promotions for skill sets we dont use?

[FW]

Listen to Ned.  There is no wiggle room here.  And, yes, if you are an employee of an Ambulance company/medical facility hired by the activity to provide support, your membership in CAP is not a factor in doing the job you are hired to do.

That is not however, what the regulation is addressing.  CAP members (acting as such) DO NOT provide routine or non emergency medical care to members (or non members) at a CAP activity (unless you wish to become one of the many "former" members of CAP ). End of story.

[SABRE17]

so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

[Krapenhoeffer]

Um... Before I bleed out from the vicious attacks of the CAPTalk hounds, I would like to add (I just realized that this might not be self-apparent), that the rule of thumb in non-life or limb cases is to "help the patient help themselves."

Lets say for instance that Cadet Snuffy has a nosebleed. Cadet Billy, who just got Basic First Aid wants to jump all over this case. Senior Member Bob, not wanting a potential cadet disaster, decides to call me over. I see Cadet Snuffy with his nosebleed. I'm not going to touch him. I know how Battery works. So instead, I pull out some gauze, and direct Cadet Snuffy in the ways of stopping his nosebleed. To make Cadet Billy feel useful, I tell him to fetch me a bag of ice. When he gets back, I tell Snuffy where to put the bag of ice. Behold the vast majority of CAP "medical emergencies."

Oh, and Sabre17, you're going to get 911 on the phone first, before you EVEN THINK of doing anything.

[Flying Pig]

so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

By Flying Pig
As  a CAP member, Nobody expects you to watch a cadet die while choking on a hot dog.  Call an ambulance, render the necessary aid, stabilize and then step back.

[SABRE17]

well of course, except 911 for me at events is the radio in my hand to the command post where my unit cc is usually standing next to the guy in charge of what ever real medical service is there.

[arajca]

so if im working an airshow etc and some one has cardiac arrest, am i gonna get kicked outta cap for providing CPR?

(i am CPR/AED/1ST AID cert)

what if some one is hit by a car near me when working in assistance with LE on a large event?

Is cardiac arrest routine or non-emergency? No. Same with someone being hit by a car.

Someone who trips and scrapes their knee is a non-emergency.

[dwb]

CAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency.

Exactly how far down the aid continuum does this go?  For example:

- Cadet participates in CPFT.  Gets a little light-headed during the mile run.  Senior member walks cadet back to a bench, provides him with some water, keeps an eye on him while he recovers.  Is this a violation of CAP regulations?

- Cadet trips and falls.  Scrapes hand, but doesn't have a first aid kit.  Asks for a band aid.  Are we to bring him to the ER to administer the band aid?  Or drive him to Wal-Mart to buy his own?

- Cadet gets blisters at encampment, doesn't have moleskin.  Do we send him home?

I know CAP members aren't going to be stitching up wounds or doing open heart surgery at a CAP activity, but what is the threshold for something being considered medical care?

[FW]

Gentlemen, there is a distinction between "First Aide" and "Medical Care".  I think you all can figure out the difference and can make reasonable decisions when the time comes to act. 
But, then again, this is Cap Talk....

[dwb]

It's not my fault that Ned uses the terms "aid" and "medical care" interchangeably.  Or maybe he really means to say that CAP members cannot provide a band aid to a cadet with a skinned knee.  I figured I would get some clarification on that.

I know, common sense and all that, but when someone who signs their posts "Former CAP Legal Officer" says "thou shalt not provide non-emergency aid of any kind, period", I'd like to have a better idea of what that means.  I don't think that's an unreasonable request.

[Krapenhoeffer]

And of course, virtually anything that isn't life or limb can be treated with Basic First Aid. I mean, the most medically severe situation I've ever had to deal with in CAP was a cadet who passed out from locking his knees (despite the best warnings of the cadet staff to not do that). That involved all of, I think, 5 seconds of Basic Life Support (assessments are part of Basic Life Support), until he responded to my voice. Called parents, cadet went home early. Badabing, badaboom. All without having to physically make contact with the Cadet.

Last time I checked you are more likely to be sued for not providing first aid than for providing it. And I consider anything we teach Cadets to be first aid.

And for Life/limb situations, well, that's what separates me from a first aider (hence the title EMERGENCY medical technician).

Now, for the "stabilize and do NOTHING else." That's kind of what an EMT does. Not to mention that you can't step back once you start stabilizing... You have to keep stabilizing. Anything beyond stabilizing can't be done without the Ambulance. And if the ambulance is undermanned, and they need me to go with, I'll just deblouse (literally and figuratively, those things get hot really quick).

And if I'm so far from civilization, that I have to, God forbid, break out Wilderness protocols... A lawsuit or a 2b is the least of my worries.

EDIT: And I will add that there are huge discrepancies in what is being said by up top. I mean, there is a "Health Services" specialty track now... But back to my main point. I define routine care as the EFARTs at the BSA camp, or a MD who happens to be a CAP member acting as a MD in a CAP capacity.

Now, during a Briefing conducted by National, they told us that CAP can be hit with liability for not providing basic first aid on a non-routine basis. After all, our MOUs state that we only field ground personnel with at least basic first aid, and that we function to that standard of care. Not to mention that since basic first aid, or whatever care they can provide is what "a reasonable person in similar circumstances" would do, we have to do it, or else we (CAP) can get hit for NOT providing care.

Remember, pretty much anything that CAP does, ES-wise, is non-routine.

[PA Guy]

CAP members at an activity may not under any circumstances render aid in anything other than a genuine life or limb emergency.

Exactly how far down the aid continuum does this go?  For example:

- Cadet participates in CPFT.  Gets a little light-headed during the mile run.  Senior member walks cadet back to a bench, provides him with some water, keeps an eye on him while he recovers.  Is this a violation of CAP regulations?

- Cadet trips and falls.  Scrapes hand, but doesn't have a first aid kit.  Asks for a band aid.  Are we to bring him to the ER to administer the band aid?  Or drive him to Wal-Mart to buy his own?

- Cadet gets blisters at encampment, doesn't have moleskin.  Do we send him home?

I know CAP members aren't going to be stitching up wounds or doing open heart surgery at a CAP activity, but what is the threshold for something being considered medical care?

My rule of thumb has always been that anything beyond mom and chicken soup kind of care is outside our scope.  In a life or limb situation activate the EMS system and provide care until they arrive.  Conducting a daily sick call with the laying on of hands, routinely dispensing OTC or legend meds, giving injections or assisting in giving injections, these are the types of things I would consider medical care.  Handing out band aids, moleskin and having someone rest for few mins. I don't consider medical care.

[FW]

And for Life/limb situations, well, that's what separates me from a first aider (hence the title EMERGENCY medical technician).

Now, for the "stabilize and do NOTHING else." That's kind of what an EMT does. Anything beyond stabilizing can't be done without the Ambulance. And if the ambulance is undermanned, and they need me to go with, I'll just deblouse (literally and figuratively, those things get hot really quick).

And if I'm so far from civilization, that I have to, God forbid, break out Wilderness protocols... A lawsuit or a 2b is the least of my worries.

I appreciate your skill set however, the regulation would keep you from providing any other care; in or out of the ambulance.  As a CAP member, IMO, you would be taking our collective posteriors with you if you determined that the ambulance was "undermanned" and made decisions which may adversely effect the (now) patient.

This regulation, BTW, was authored by two very respected physician members of CAP.  One is our chief HSO and the other the chief of EM at a large metropolitan hospital.  Yes, our lawyers were involved too.  We live in very interesting times....